<?php $this->load->view('provider/template/_begin') ?>
<?php $this->load->view('provider/template/_index') ?>
<script type="text/javascript">
  var country_id = 0;
  jQuery(document).ready(function(){    
    jQuery("#form_forgot_pass").validationEngine();
  });
</script>
<div class="w6 cpos_1 mg5">
  <div class="box_title">Forgot your account or password</div>
  <div class="box_bg"><br />
    <form action="<?php echo site_url('provider/forgot_password/process') ?>" method="post" id="form_forgot_pass">
      <table class="table1">
        <tbody>
          <tr>
            <td class="text4">Email:</td>
            <td>
              <input id="email" type="text" name="email" value="" placeholder="Email" 
                     class="input2 validate[required,custom[email]]"/>
            </td>
          </tr>
          <tr>
            <td class="text4">Captcha:</td>
            <td>
              <input id="captcha" type="text" name="captcha" value="" placeholder="captcha" 
                     class="input2 validate[required]"/>
            </td>
          </tr>
          <tr>
            <td></td>
            <td><?php echo $captcha['image'] ?></td>
          </tr>
          <tr>
            <td colspan="2" class="center">
              <div class="button2 mg7" style="margin-left: 0px;margin-top: 20px">
                <div class="button_left"></div>
                <div class="button_bg">
                  <a href="#" onclick="$('form').submit();return false;">Submit</a>
                </div>
                <div class="button_right"></div>
              </div>
              <div style="margin-top: 30px">
                <a href="<?php echo site_url('provider/signup') ?>">Sign up</a>   |   
                <a href="<?php echo site_url('provider') ?>">Log in</a></td>
              </div>
          </tr>
        </tbody>
      </table>
    </form>
    <div class="clearer"></div>
  </div> 
  <div class="box_fotter"></div>
</div>
<?php $this->load->view('provider/template/_end') ?>    